Who Crapped In The Bride’s Asparagus?

Food Safety News – The second largest foodborne outbreak of Shigella flexneri in more than 30 years struck guests at an Oregon wedding last August.

Shigella flexneri is a Gram-negative, enteric pathogen and together with three other Shigella species, Shigella dysenteriae, Shigella sonnei, and Shigella boydii is responsible for about half a million cases of shigellosis in the United States each year.

“Shigella leaves the body through human feces. The disease spreads when bacteria from the stool of the sick person go to the mouth of another person.” – WebMD

The source of the Shigellosis contamination was not identified definitively for the Aug. 11 wedding and reception in Oregon’s Yamhill County.

“Poor food-handler hygiene is the most likely cause”

“Because humans are the natural reservoir for Shigella species, and there were no concurrent outbreaks to suggest upstream contamination, poor food-handler hygiene is the most likely cause,” says a recent Oregon Health Authority summary report.

[“Poor food-handler hygiene” means a server failed to wash their hands after using the toilet. – Ed.]

Wedding and reception guest reports of gastrointestinal illnesses brought on an investigation by the Oregon Health Authority (OHA) and the Yamhill County Health and Human Services Department by Aug. 14.

Purpose of the investigation was to determine the cause of the foodborne outbreak and prevent additional cases. The Oregon Department of Agriculture, which regulates food -food service establishments joined the investigation.

A Health Alert Network notice was sent out on Aug. 15 after ten cases had been reports.

It asked patients with gastrointestinal illnesses to submit stool samples and asked if they’d attend the Yamhill wedding and reception.

“Fecal samples from patients were cultured and isolates serotyped at the Oregon State Public Health Laboratory,” the summary report says.

On Aug.20, Shigella flexneri type 3a was first identified from a patient specimen.

OHA consulted with subject matter experts at the Centers for Disease Control and Prevention (CDC) for information on this Shigella serotype,”

Yamhill County on Aug. 16 put up an online survey for guests attending the wedding and reception and contacted caterer for the event. The study collected data on foods consumed and the wedding and any illnesses that resulted.

A second online survey got underway on Aug. 20 after investigators learned there was a cocktail hour between the wedding and reception.

Out of 263 wedding and reception guests, 192 responded to the first survey and 128 to the second. Some people completed a survey for others, such as children.

The surveys were combined, showing 107 Shigellosis cases with 23 or 21 percent confirmed. The wedding and reception guests came from 12 states, with 82 or 77 percent being Oregon residents.

Persons attending the rehearsal dinner were no more likely to become ill than those who attended only the main event.

Reception service was buffet style. The epidemiologic investigation focused on food-exposures. “Five food items were each associated with a significantly increased risk of illness: asparagus, butter, bread, au gratin potatoes and the aioli that was served with the asparagus.” The report adds:

“Asparagus was most strongly associated with illness: of those who ate asparagus, 64 percent became ill, compared to 12.3 percent of those who denied eating asparagus.”

Only bread remained significant when compared to asparagus.

No food-handling violations were discovered when Multnomah County inspectors visited the caterer. The caterer and its food handlers submitted stool samples, and all came back negative for Shigella.

The caterer’s records showed the same dishes were served at other events, but those did not result in illnesses. Asparagus was sourced locally. Water was tested for bacteria, and those tests were also negative.

Food Poison Journal – On August 14, 2018, the Oregon Health Authority (OHA) and Yamhill County Health and Human Services (YCHHS) independently received reports of persons with gastrointestinal illness days after attending a wedding and reception in Yamhill County on August 11. Over the next two days, additional wedding attendees reported gastrointestinal illness.

OHA notified the Multnomah County Health Department (MCHD), and the agencies initiated an investigation to determine the cause of the outbreak and to prevent additional cases.

YCHHS contacted the Oregon Department of Agriculture (ODA), which regulates some food-service establishments in Oregon.

By August 15, 10 cases had been reported to OHA. A Health Alert Network notice was sent to the ORCD1 group,1 advising them to ask patients with gastrointestinal illness whether they had attended a wedding in Yamhill County and, if they were willing, to submit a stool sample.

Fecal samples from patients were cultured and isolates serotyped at the Oregon State Public Health Laboratory. On August 20, Shigella flexneri type 3a was first identified from a patient specimen.

OHA consulted with subject matter experts at the Centers for Disease Control and Prevention (CDC) for information on this Shigella serotype.

METHODS

Methods YCHHS public health investigators obtained contact information for attendees and the caterer. The caterer is based in Multnomah County. MCHD officials contacted the caterer to obtain a menu of foods served at the wedding.

Using this information, on August 16 OHA epidemiologists emailed to wedding attendees a link to an online survey asking them to identify foods they had eaten and to determine whether they had illnesses meeting the case definition.

Information from the first survey indicated that there was a cocktail hour between the wedding ceremony and the reception.

Because S. flexneri infections have been associated with international travel,2 and there were additional food exposures, OHA invited wedding attendees to complete a second online survey on August 20. OHA asked respondents about their illness on this survey, too.

A confirmed case had S. flexneri cultured from a clinical specimen. A presumptive case was defined as self-reported diarrhea or vomiting in a person who attended the wedding reception.

Well-water samples were tested using the Colilert test for total coliforms. Food samples were tested for Shigella species using polymerase chain reaction testing. Multnomah County environmental health specialists inspected the caterer. They observed hygiene practices and asked that people who prepared food for the reception submit stool samples for testing.

RESULTS

Among 263 wedding attendees and reception venue staff, 192 were represented on the first survey and 128 on the second survey; some people completed the survey for their children, spouses, or other relatives. In total, 200 people were represented by the two surveys combined.

One hundred seven cases were identified, of which 23 (21%) were confirmed. Eighty-two (77%) of the cases were Oregon residents; the remainder were residents of 11 other states. Oregon cases resided in 11 different counties.

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